Aim High level evidence recommends the use of mesh for umbilical hernias with defects >1 cm to reduce recurrence rates without increasing the risk of postoperative complications. For umbilical hernias with defect width ≤1 cm, the literature is sparse. The aim of the study was to assess outcomes after suture and mesh repair of umbilical hernias with defect width Material and Methods By merging data from the Danish Hernia Database and the National Patients Registry from January 2007 until December 2018, patients receiving elective repair of an umbilical hernia with defect width ≤1 cm were identified. Available data included details about comorbidity, surgical technique, 90-days readmission, 90-days reoperation and reoperation for recurrence. Results A total of 7,849 patients were included, of whom 25.7% (2,013/7,849) underwent mesh repair. The cumulative 5-year incidence of reoperation for recurrence was significantly decreased after mesh repair 3.1% (95% C.I. 2.1-4.1) compared with suture repair 6.7% (95% C.I. 6.0-7.4), P Conclusions Even for the smallest umbilical hernias, mesh repair significantly decreased the recurrence rate. Onlay mesh repair was associated with the lowest risk of recurrence without increasing early complications.